MEDICARE: MR. WINSTON HARRIS II PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	778523	WI
2	363A00000X	Physician Assistant	778523	WI
3	363AS0400X	Surgical Physician Assistant	778523	WI

General Provider Information

NPI Number	:	1487417887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WINSTON HARRIS II PA-C

Provider Business Mailing Address
First Line	:	8383 GREENWAY BLVD STE 210
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-3506
Country	:	US
Telephone Number	:	608-831-1766
Fax Number	:

Provider Business Practice Location Address
First Line	:	8383 GREENWAY BLVD STE 210
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-3506
Country	:	US
Telephone Number	:	608-817-0965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	12/01/2025

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